FHIR R4 Resource - Claim
OpenIMIS openIMIS tables mapped - tblClaim , tblClaimItems , tblClaimServices
FHIR R4 field | OpenIMIS openIMIS field | notes | mapping status | |||||
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Identifieridentifier | tblClaim.ClaimID / tblClaim.ClaimUUID / tblClaim.ClaimCode | Claim can have multiple identifiers. The most important one is mapped from ClaimCodeClaimUUID. | ClaimID and ClaimCode mapped | |||||
one of [entered, checked, reviewed, valuated] based on tblClaim.ClaimStatus | entered state by default | |||||||
tblClaim.InsureeIDInsureeUUID | reference to Patient resource | mapped - mandatory | ||||||
tblClaim.DateFrom / tblClaim.DateTo | date from DateFrom and date to DateTo are mapped to a period of time between them | mapped - mandatory | ||||||
tblClaim.ICDID / tblClaim.ICDID1 / tblClaim.ICDID2 / tblClaim.ICDID3 / tblClaim.ICDID4 | ICDID values are mapped to a list of diagnosis | mappedreference to Condition resource There is an error with the POST for both versions. When the error is found complete the mapping. | mapped - mandatory from fhir to imis not mapped (diagnosis) | |||||
provider | tblClaim.Adjuster | to be validated | not mapped | claimCode | dateFrom | dateTo|||
tblClaim.Claimed | mapped as Money data type | mapped - mandatory | ||||||
tblClaim.DateClaimed | mapped - mandatory | |||||||
supportingInfo | tblClaim.Explanation / tblClaim.GuaranteeId / tblClaimItems.Availability / tblClaimItems.Explanation / tblClaimServices.Explanation | information category is distinguishing the type of information | mapped | |||||
ClaimAttachment | ||||||||
tblClaim.HFID | reference to HealthcareService resource | mapped - mandatory | ||||||
tblClaim.ClaimAdminId | reference to Practitioner resource | mapped | ||||||
tblClaim.VisitType | mapped - mandatory | |||||||
item.productOrService | tblClaimItems.tblItem.ItemId ItemCode / tblClaimServices.ServiceID | claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItems | mapped | item.quantity | tblClaimItems.QtyProvided / tblClaimServices.QtyProvided | claim.item.category.text is distinguishing whether mapping is done from tblClaimsServices or tblClaimItemstblServices.ServiceCode | actual Code value | mapped - mandatory |
item.extension.productOrServiceReference | tblClaimItems.ItemUUID / tblClaimServices.ServiceUUID | reference to Medication resource if medical item | mapped | |||||
item.quantity | tblClaimItems.QtyProvided / tblClaimServices.QtyProvided | mapped | ||||||
item.unitPrice | tblClaimItems.PriceAsked / tblClaimServices.PriceAskedclaim. | price could differ from the price defined in medical item/service definition | mapped | |||||
item.category.text is distinguishing | “service” or “item” | distinguishing whether mapping is done from tblClaimsServices or tblClaimItems | mapped |
Endpoint specification:
Example of endpoint URL:
http://localhost:8000/api_fhir_R4/Claim/
Supported HTTP operation:
CREATE - used to submitting the claim. The FHIR claim representation is converted to python ClaimSubmit (https://github.com/openimis/openimis-be-claim_py/blob/master/claim/services.py#L38 ) which is used by the python claim service. List of supported fields can be found in the table which shows the mapping between OpenIMIS and FHIR. Should be used the POST HTTP method and the body as JSON representation (example can be found below).
Note:
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The claim service is used to process the request (https://github.com/openimis/openimis-be-claim_py/blob/master/claim/services.py#L146 ).
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- mandatory | |||
provider | tblClaimAdmin.ClaimAdminUUID | reference to PractitionerRole resource | mapped for db tool reason |
priority | code = “normal” | CodeableConcept | mapped for db tool reason |
use | “claim” | mapped for db tool reason | |
status | “active” | mapped for db tool reason | |
claim.insurance.focal | True | mapped for db tool reason | |
claim.insurance.sequence | 0 | mapped for db tool reason | |
claim.insurance.coverage | tblPolicy.PolicyUUID | reference to Coverage resource | mapped for db tool reason |
Endpoint specification:
Example of endpoint URL:
http://localhost:8000/api_fhir_r4/Claim/
Supported HTTP operation:
POST - used to submit a new claim. List of supported fields can be found in the table which shows the mapping between openIMIS and FHIR and the body has JSON representation (example can be found below).
The response is:OperationOutcome which notice about the failure (list of possible errors);
ClaimResponse which notice about the success.
READ GET - by default return list of all available resources. To fetch information about a specific object you should add the primary key Claim UUID to URL for instance:
http://localhost:8000/api_fhir_R4r4/Claim/{claimcode}
, where "{claimcode}" is the value of the primary key (claim code in case of that resource). Should be used the GET HTTP method.UPDATE - the ClaimUUID}PUT - the operation currently not supported
DELETE - the operation currently not supported
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Configuration key | Description | Default value | ||
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default_audit_user_id | default value which will be used for 'audit_user_id' field | "default_audit_user_id": 1, | ||
R4_fhir_identifier_type_config | configuration of system and codes used to represent the specific types of identifiers | "R4_fhir_identifier_type_config":{ }, R4_ "fhir_issuecode_type_config | configuration of system and codes used to represent the specific types of operation outcome | "R4_fhir_issue_type_config":{for_imis_location_code_type":"LC", |
R4_fhir_claimissue_type_config | configuration of system and codes used to represent the specific types of claim codesoperation outcome | "R4_fhir_issue_claimtype_config":{ | ||
"R4_fhir_claim_item_code":"item", | configuration of system and codes used to represent the specific types of claim codes | "R4_fhir_claim_service_codeconfig":"service",{ }, |
Example JSON representation of content:
As in the other resources there is an error and therefore this file is shown.
Code Block | "fhir_claim_item_status_rejected_code":"rejected", |
Claim Attachments
The following mapping is considered:
FHIR Field | openIMIS Field | Description | ||||||
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One element for each attachment. | ||||||||
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The content of the attachment.
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ClaimAttachment.mime | The document mime type (e.g.
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ClaimAttachment.document | The attachment content data as base64. Not available for GET ALL Claims.
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N/A | Only for POST Claim. SHA-1 hash value of the data as base64 to validate the data. If missing, data is not validated.
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ClaimAttachment.filename | Filename
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ClaimAttachment.date | Date attachment was created. If missing, current date and time.
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Example JSON representation of content
As in the other resources there is an error and therefore this file is shown.
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